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N-terminal pro-B-ty...
N-terminal pro-B-type Natriuretic Peptides Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds
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- Potgieter, Danielle (author)
- University of KwaZulu Natal, South Africa
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- Simmers, Dale (author)
- University of KwaZulu Natal, South Africa
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- Ryan, Lisa (author)
- Greys Hospital, South Africa
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- Biccard, Bruce M. (author)
- University of KwaZulu Natal, South Africa
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- Lurati-Buse, Giovanna A. (author)
- University of Basel Hospital, Switzerland
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- Cardinale, Daniela M. (author)
- European Institute Oncol, Italy
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- Chong, Carol P. W. (author)
- Northern Hospital, Australia; University of Melbourne, Australia
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- Cnotliwy, Miloslaw (author)
- Pomeranian Medical University, Poland
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- Farzi, Sylvia I. (author)
- Medical University of Graz, Austria
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- Jankovic, Radmilo J. (author)
- University of Nis, Serbia
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- Kwang Lim, Wen (author)
- Medical University of Graz, Austria
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- Mahla, Elisabeth (author)
- Medical University of Graz, Austria
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- Manikandan, Ramaswamy (author)
- Stepping Hill Hospital, England
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- Oscarsson, Anna (author)
- Linköpings universitet,Avdelningen för läkemedelsforskning,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Phy, Michael P. (author)
- Texas Technical University, TX 79430 USA
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- Rajagopalan, Sriram (author)
- University of Aberdeen, Scotland; Aberdeen Royal Infirm, Scotland
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- Van Gaal, William J. (author)
- University of Melbourne, Australia
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- Waliszek, Marek (author)
- M Pirogow Prov Specialist Hospital, Poland
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- Rodseth, Reitze N. (author)
- University of KwaZulu Natal, South Africa; Cleveland Clin, OH 44106 USA
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(creator_code:org_t)
- LIPPINCOTT WILLIAMS and WILKINS, 2015
- 2015
- English.
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In: Anesthesiology. - : LIPPINCOTT WILLIAMS and WILKINS. - 0003-3022 .- 1528-1175. ; 123:2, s. 264-271
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background:N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. Methods: The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. Results: The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (less than100 patients) a single cohort threshold was associated with an OR of 5.4 (95% CI, 2.27 to 12.84) as compared with an OR of 14.38 (95% CI, 6.08 to 34.01) for study-specific thresholds. Conclusions:Post hoc identification of study-specific prognostic biomarker thresholds artificially maximizes biomarker predictive power, resulting in an amplification or overestimation during meta-analysis of these results. This effect is accentuated in small studies.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
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- ref (subject category)
- art (subject category)
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Potgieter, Danie ...
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Simmers, Dale
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Ryan, Lisa
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Biccard, Bruce M ...
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Lurati-Buse, Gio ...
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Cardinale, Danie ...
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Chong, Carol P. ...
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Cnotliwy, Milosl ...
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Farzi, Sylvia I.
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Jankovic, Radmil ...
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Kwang Lim, Wen
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Mahla, Elisabeth
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Manikandan, Rama ...
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Oscarsson, Anna
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Phy, Michael P.
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Rajagopalan, Sri ...
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Van Gaal, Willia ...
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Waliszek, Marek
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Rodseth, Reitze ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Anesthesiology
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Linköping University